分别基于行为疗法和口服帕罗西汀在治疗功能性腹痛综合征中的临床研究

目的探讨功能性腹痛综合征（FAPS）患者症状与精神心理状态的联系,比较分别基于行为疗法与口服帕罗西汀在治疗FAPS中的作用。方法以症状自评量表（SCL-90）评价FAPS患者和健康志愿者的心理状态,并与国内常模比较。将确诊为FAPS患者随机分为松弛行为疗法组和口服帕罗西汀组,记录每位患者治疗前后的症状（严重程度及影响程度）评分及相关因子分值,采用样本非参数检验进行统计学分析。记录患者及健康志愿者性别、是否绝经、年龄、文化程度、经济状况、对目前工作生活满意度及过去6个月有无重大负性事件,采用非条件Logistic回归分析发病危险因素。结果FAPS患者SCL90评价阳性率显著高于健康志愿者,部分因子分值高于国内常模,焦虑因子与FAPS症状严重程度呈显著相关,精神病性与强迫因子呈显著相关（P〈0.05）。治疗2周后,组内比较显示帕罗西汀组症状显著改善,组间比较显示帕罗西汀改善疼痛优于松弛疗法。治疗8周后,组内比较显示松弛疗法和口服帕罗西汀改善症状与焦虑因子分值差异均有统计学意义（P〈0.01）;组间比较差异无统计学意义（P〉0.05）。非条件Logistic回归分析,负性事件为密切相关危险因素。结论口服帕罗西汀治疗FAPS的短期疗效优于行为疗法,8周后2种方法总体疗效无显著差异;松弛行为疗法更易于患者接受,且成本/效益比优于口服药物。

The clinical research of treatment for functional abdominal pain syndrome: Behavior therapy and oral paroxetine therapy

Objective To investigate the relationship between the symptoms and psychological situation of patients with functional abdominal pain syndrome（FAPS）,and compare the behavior therapy and oral paroxetine therapy in the treatment of FAPS.Methods To evaluate the psychological status in patients and normal volunteers with symptom checklist（SCL-90）,and compare with domestic mode.The patients with FAPS were randomly assigned to the relaxation behavior therapy group and the oral paroxetine group,the score of FAPS symptom（severity and influence degree） and related factors in each patient before and after treatment were recorded,sample non-parameter test was applied for the statistical analysis.Sex,menopause or not,age,education level,economic conditions,current work and life satisfaction degree,whether have major negative events in recent 6 months were recorded,non-conditional Logistic regression was used to analyze risk factors.Results The positive value of FAPS by SCL-90 evaluation was significantly higher than the normal volunteers,and part of factorial score was higher than the domestic mode,anxiety factor was significantly correlated with the FAPS symptom（P0.05）.After 2 weeks treatment,the effect in paroxetine group was better than relaxation therapy group in comparison with intra-and inter-groups.After 8 weeks treatment, there are significant difference intra-groups of relaxation therapy and oral paroxetine therapy in release symptom and improve anxiety factor score（P0.01）.There was no statistical difference between groups（P0.05）.Non-conditional Logistic regression analysis shows negative event was related risk factor.Conclusion Short term improvement of FAPS by oral paroxetine is better than behavioral therapy,after 8 weeks treatment,follow up evaluation of the overall efficacy of two methods shows no significant difference.Relaxation behavior therapy is prone to accept by patients and cost/benefit ratio is better than oral medication.